Weighty issues: fertility and the media

The media storm over the British Fertility Society's (BFS) statement on social values took us all by surprise. We had issued a press release about a forthcoming paper in the journal Human Fertility, commenting on the lack of implementation of NICE (National Institute for Health and Clinical Excellence) fertility guidance by Primary Care Trusts (PCTs), and making some proposals to help standardise access to treatment across England. We assumed that we would get some reasonable coverage on the inside pages, but dealing with the press is not an exact science. Instead, we were overwhelmed by the prominence given to the news story, but also by the concentration on the obesity issue to the exclusion of all else. How did this happen?

Interestingly, some of the first reports were very balanced - Sarah Boseley's in the Guardian was a very good example (1). But from speaking to journalists later, it emerged that it was obvious that one broadsheet in particular had decided that the coming together of two fairly combustible media elements - obesity and fertility - meant that the story lay there. This created something of a bidding war, and we saw the newspapers changing their initial stories and concentrating on obesity, and the news value of the story began to climb. From there, the broadcast media followed.

Journalists do a very difficult job to impossible deadlines, and in putting their comment forward they lay themselves open to people like me picking over the bones of a story later. However, much of the impression that a newspaper story makes depends on the sub-editor who writes the eye-catching headline, and this is what happened here. The headline became obesity and fertility, even though a lot of the stories underneath still carried a lot of balance. What this meant was that as secondary reports or comments came in, they seemed increasingly to be based on the impression made by previous stories, rather than on our original press release. Take for example the late comment piece on the Guardian website (2) (see 'Recommends'), where the writer talks of '...new recommendations that IVF treatment on the NHS should be limited or withdrawn entirely for overweight women'. This Guardian web article draws it's report from an earlier Times article (3). By this time, the story had taken on it's own momentum.

So what did the BFS [actually] say about female weight? The document commented that whilst the NICE guidelines had made recommendations for the management of fertility when the woman has a Body Mass Index of more than 29, that some PCTs had applied this as a funding criteria. The paper argued that this was wrong and that PCTs should, as part of their commissioning arrangements, provide such women with appropriate dietary support and exercise programmes to reduce their BMI (Body Mass Index). Moreover, it argued that in the absence of any other evidence, the only current sensible upper BMI limit for assisted conception might be that currently accepted by anaesthetists as defining fitness for day case surgery (i.e. less than 36). Hardly draconian and far above that currently being applied by most PCTs.

Over the last few days the BFS has come in for public criticism for apparently discriminating against obese women (we've also had complaints about suggesting allowing access to treatment for lesbian women, but far fewer). Interestingly, we also suggested that women with a BMI of less than 19 should also show some progress in gaining weight before being accepted for NHS treatment, but I doubt that you'll find an article about that. In most respects, it was the press that made this an obesity story.

Dealing with the press can be occasionally frustrating, sometimes depressing, and now and then it makes me want to scream. But it's also useful, and the rewards can be great, and I wouldn't want to do anything else. In some respects, putting out a press release is like having children, you know how you want them to turn out, but usually they end up with a life of their own. But I suppose that's what fertility is all about?